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Impact of Providing Preexposure Prophylaxis for Human Immunodeficiency Virus at Clinics for Sexually Transmitted Infections in Baltimore City

An Agent-based Model

Kasaie, Parastu, PhD*; Berry, Stephen A., MD; Shah, Maunank S., MD, PhD; Rosenberg, Eli S., PhD‡§; Hoover, Karen W., MD, MPH; Gift, Thomas L., PhD; Chesson, Harrell, PhD; Pennington, Jeff, BS*; German, Danielle, PhD*; Flynn, Colin P., ScM**; Beyrer, Chris, MD, PhD*; Dowdy, David W., MD, PhD*

doi: 10.1097/OLQ.0000000000000882
Original Studies

Background Preexposure prophylaxis (PrEP) greatly reduces the risk of human immunodeficiency virus (HIV) acquisition, but its optimal delivery strategy remains uncertain. Clinics for sexually transmitted infections (STIs) can provide an efficient venue for PrEP delivery.

Methods To quantify the added value of STI clinic–based PrEP delivery, we used an agent-based simulation of HIV transmission among men who have sex with men (MSM). We simulated the impact of PrEP delivery through STI clinics compared with PrEP delivery in other community-based settings. Our primary outcome was the projected 20-year reduction in HIV incidence among MSM.

Results Assuming PrEP uptake and adherence of 60% each, evaluating STI clinic attendees and delivering PrEP to eligible MSM reduced HIV incidence by 16% [95% uncertainty range, 14%–18%] over 20 years, an impact that was 1.8 (1.7–2.0) times as great as that achieved by evaluating an equal number of MSM recruited from the community. Comparing strategies where an equal number of MSM received PrEP in each strategy (ie, evaluating more individuals for PrEP in the community-based strategy, because MSM attending STI clinics are more likely to be PrEP eligible), the reduction in HIV incidence under the STI clinic-based strategy was 1.3 (1.3–1.4) times as great as that of community-based delivery.

Conclusions Delivering PrEP to MSM who attend STI clinics can improve efficiency and effectiveness. If high levels of adherence can be achieved in this population, STI clinics may be an important venue for PrEP implementation.

Clinics for sexually transmitted infections are highly effective venues for implementation of preexposure prophylaxis among men who have sex with men by improving efficiency of screening and effectiveness of preexposure prophylaxis.

From the *Bloomberg School of Public Health,

School of Medicine, Johns Hopkins University, Baltimore, MD;

Department of Epidemiology and Biostatistics, School of Public Health, University at Albany, Rensselaer, NY;

§Rollins School of Public Health, Emory University;

Division of HIV/AIDS Prevention,

Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, CDC, Atlanta, GA; and

**Maryland Department of Health and Mental Hygiene, Baltimore, MD

Conflict of interest: None declared.

Sources of Funding: This work was supported by US Centers for Disease Control and Prevention (Enhancing Models of HIV, Viral Hepatitis, STIs, and Tuberculosis to Inform and Improve Public Health Impact, U38PS004646) for P.K., M.S.S., E.S.R., J.P., D.W.D. P.K. was supported by Johns Hopkins University Center for AIDS Research (P30AI094189).

The findings and conclusions in this paper are those of the authors and do not necessarily represent the views of the Center for Disease Control and Prevention.

Correspondence: David W. Dowdy, MD, PhD, Room E6531, 615 N. Wolfe St, Baltimore, MD 21205. E-mail:

Received for publication December 15, 2017, and accepted June 20, 2018.

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© Copyright 2018 American Sexually Transmitted Diseases Association